Coronary sinus dissection during left ventricular pacing electrode implantation

Area of Science:

• Cardiology
• Cardiac Electrophysiology
• Interventional Cardiology

Background:

• Biventricular pacing is crucial for managing heart failure and ventricular arrhythmias.
• Coronary sinus (CS) electrode placement is key for biventricular pacing, but carries risks.
• CS dissection is a rare but serious complication during lead implantation.

Observation:

• A 71-year-old female with dilated cardiomyopathy, recurrent ventricular tachycardia, and heart decompensation underwent cardioverter-defibrillator implantation.
• During CS catheterization, dissection occurred, leading to a left ventricular hematoma.
• Despite the complication, the pacing lead was successfully implanted in the posterolateral vein using an "over-the-wire" technique.

Findings:

• Postoperative electrocardiogram showed a reduced QRS duration, indicating improved ventricular synchrony.
• Echocardiography demonstrated a reduction in left ventricular dimensions.
• Left ventricular function showed significant improvement following the procedure.

Implications:

• This case highlights that successful biventricular pacing lead implantation is achievable even after CS dissection.
• The "over-the-wire" technique offers a viable solution for navigating CS dissection during lead implantation.
• Effective management of CS dissection can lead to improved cardiac function and patient outcomes in heart failure patients.